Ep. 129: Sexual Health, Vaginal Dryness, and How To Keep Your Lady Bits Young Interview with Dr. Anna Cabeca

Robyn:                                Hey everyone, and Welcome back to the Vibe show. I’m Robyn Openshaw and I’m your host and today I’m bringing you some interesting content. It’s all about lady bits. It’s about our sexual health, which isn’t just about sex. Our sexual health is about our aging. It’s about how we feel. It’s about how we feel about our guy, our partner. There’s a lot here that we’re going to dive into.

This past week I did a Facebook live with my friend and colleague, Dr. Anna Cabeca, who is a gynecologist who has definitely gone way down the rabbit hole after being traditionally trained, and was doing surgeries and doing the whole synthetic hormone, all of that. In her own saga, she learned to dig deeper and to go to root cause and figure out what is going on with women rather than just drugging them or cutting parts out.

I’m not going to get into this with her on the interview today because it’s a tough thing to talk about, but we have something in common that she and I have compared notes on before and that is that we both went through a very traumatic event that caused overnight menopause. Now it happened for her at 38 and she was in I believe a second marriage and she wanted to have another baby, so here she is in overnight menopause. What caused her instant menopause was trauma. We both did the two known biggest life stressors there are, she lost a child. I went through a divorce at 20 years in.

And when we got talking on this Facebook live, it was insane. We had almost 20,000 people watching. Women didn’t want to let her go because they started to realize, oh my gosh, we can have a conversation that we can’t have anywhere else. And they were talking about hysterectomies and they were talking about endometriosis and Polycystic Ovarian Syndrome and why women are losing their libido in midlife.

They wanted to ask about breast implants and pelvic floor issues. Talking about, you know when they sneeze and they pee a little bit, this is going to affect your social life. How to do kegels. Okay, so doctor Anna teaches exactly how to do them right. I’m going to point you to a blog post where she kinda tells all, because I published it on my site. It is unique content that she wrote for our audience.

What kind of hormone replacement she likes or doesn’t like. So we’re going to deep dive into all of that with her today. Her background is that she’s an Emory trained gynecologist and a women’s health expert. Again, she was diagnosed with early menopause and she was able to reverse it after traveling around the world, diving deep into things that are outside of American Western medicine. She’s now a triple board certified menopause and hormone expert and she’s really internationally acclaimed for her work in gynecology and obstetrics, integrative medicine and anti-aging and regenerative medicine.

So she’s really impacted the lives of thousands of women across the globe. I feel very blessed to call her a friend and colleague. And she’s fun and honest and open. And we are going to talk about some things today that you might not have ever heard discussed in open dialogue. So here we go.

So Welcome to the Vibe show Doctor Anna Cabeca.

Dr. Anna Cabeca:              Thank you. Thanks Robyn for having me.

Robyn:                                So I’ve given a little bio including the fact that both of us went through early menopause. Is that what makes you such an advocate for women’s health and willing to go into the areas of functional medicine and finding root cause and correcting hormone imbalances in a natural way. Because I don’t imagine that medical school really trained you in such holistic ways that you’ve gone into. Tell us a little bit about what in your background made you want to do this with your career.

Dr. Anna Cabeca:              Yeah, certainly medical school and even residency, you know, doesn’t prepare us for all the curve balls that life throws at us. And for me, my personal journey was from menopause at age 38 being diagnosed with permanent irreversible menopause. I was told I was never able to have another child and that would be it. And it didn’t make sense to me, but there was nothing I knew that could really help me. And I dug even deeper into functional medicine.

I already knew functional medicine because being an advocate for women’s health. But growing up, Robyn, my mom was sick all the time. She was this strong, powerful, brilliant woman, an immigrant to America, married my dad who was in World War II and he met her in the Middle East, brought her back to the states and she struggled with postpartum depression, diabetes and heart disease. And when I was 16 years old, she was requiring a cardiac bypass surgery.

Now that was just insane to me to be so young. And I at 16 looked at the research. Well, everything was done on men. There weren’t studies in women. So that, first off put me to be an advocate. But then what I saw happen with my mom and her two brothers out of nine that came to the US the others stayed in war torn Middle East. These three all died in their 50’s or 60’s. Mom was 67 when she died. Her two brothers died in their 50’s. And the others, you know, I have an aunt and uncle both in their eighties still living well. And it made me realize, like what are we doing wrong.

At the time of my mom’s death at age 67 approximately 15 years after her cardiac surgery, she was on 11 medications Robyn. I was an OBGYN resident at Emory at that time. And we had the best surgeon. But you know, despite the best surgery, my mom didn’t make it off the table, didn’t make it out of the recovery room. And that really dug deep into my core. It’s like, what am I missing? What was the cause for her to experience this because it didn’t make sense and I needed to understand this.

And that’s where I really started looking at more functional medicine, food as medicine. What our genes and our environment, how they play a big role in our health. And so that was in the 1990’s when I was in medical school and residency at that time. So that really stuck with me. You know, I would do OBGYN rounds and I would think, what else can I do for this patient that’s not part of our standard protocols? You know, is it nutrition? Is it manipulation? Is it, you know, what else can we do?

And then I went into private practice as a National Health Service Corps. I worked for the U S Navy before med school and then received a national health service corps scholar. So I came to a small town in rural Georgia. And in the private practice, I had to get creative for my clients that were from all different demographics.

But, again, deepening my study into functional medicine was because one of my daughters was very hyperactive and you know, so much energy, right? But she needed medication to focus and that didn’t jive with me. And so that led me to investigate functional medicine testing, understanding physiology, and how that was affecting her. So organic acid testing and that was foundational.

But then, you know, a few years later I hit my own menopause and tried, went on a journey honestly around the world to figure that out. So it’s been just empowering women and wanting everyone to know that they have the power within them to be better tomorrow than they are today.

Robyn:                                I love it. There’s so many questions we got during our Facebook live. It was crazy. I’m just going to touch on some of them. And then I’m going to give you the question, in your practice, what kinds of problems do you see most often with women that you can really help them with? Because you know, I’ve had several people very close to me have complete hysterectomies in their thirties and forties. And it just seems to be happening a lot. And I’m concerned that that’s the only solution that’s being offered. Well, let’s just take something out. It’s like if something’s going wrong with your gallbladder, well just take it out. If you have endometriosis, let’s just cut out all the organs involved.

These are the things we heard from people. Nikki saying: “I’m dried up like a prune and no hormones or sexual desire. I’m only 59” Lisa said, “I’m 58 years old, had my total hysterectomy at age 32 years old. My ovaries grew huge cysts. My uterus was full of endometriosis. Not taking any medication. I’m a regular yoga coach and I’m doing exercises to help the pelvic floor, but now I’m older. I have pain during intercourse and no more pleasure. Help me”.

Lisa says: “Dryness, low libido”. Carrie said: “After five babies and a c-section, my pelvic floor needs help bad. I have terrible bladder issues going potty nonstop”. Jill told us: “One doctor I go to says bio identical (that’s a natural hormone replacement) is a waste of money. He said, only take the synthetics. My other doctor likes bioidenticals”.

The list goes on and on. People talking about painful intercourse and difficulty with orgasm later in life, which of course if intercourse is painful, you’re not going to have the pleasure associated. So lots of different things. You don’t have to go to all of them. But what are some of the most common symptoms you’re seeing women struggle with?

Dr. Anna Cabeca:              Yeah, and I think that’s all of the above. And with every one of these cases I’m like, you can get better. You can get better. You’ve had a hysterectomy, you can get better. So Robyn, I’ll tell you kind of how I started my practice, you know, like how our standard approach was and then how I converted it. Because as a result of the integrative approaches that I empowered my patients with, right? Because ultimately they’ve got to do it. You know, a little bit of help from me, maybe some bio-identical hormone, maybe some “Julva” and some “Mighty Maca Plus”, right? Those are solutions that I’ve created to help women because I just didn’t have anything out. But most of it over 90% is in the patient’s hand.

And so, for example, typically one thing that we see so common as a gynecologist, patients come in for the annual pap smears or in between because they’re having PMS symptoms, irregular, painful, cramping with their periods, migraines, headaches with their periods. And then of course the ovarian cyst issues or pelvic pain or discomfort. And also in my practice, I did my own ultrasounds, so I could see what was going on too and be able to monitor clients get better in a very hands on way.

But, so when a client comes in typically with those symptoms, one of the first things in our doctor’s bag is, okay, well we can put you on birth control pills cause that’ll knock out your periods. And for the PMS, let’s just give you an SSRI, Selective Serotonin Re-uptake Inhibitor, like Prozac, Zoloft, the list goes on. Then come back and we’ll see how you’re doing. And then typically the patient will come back with continued discomfort or side effects from the pills or from the medication. They’re still not feeling good, having heavier bleeding, cramping, or we’re noting fibroids and ovarian cysts and the client doesn’t feel any better.

So then the solution is, well let’s just, you know, do a hysterectomy and since you’re over age 35, we should take your ovaries out so you avoid that very small chance of ovarian cancer. And so, you know, I’m saying that tongue in cheek, it’s a real issue, but it’s exactly what happens. And that’s unfortunate. And that puts clients into menopause right away. And even if we conserve the ovaries, leave the ovaries in, that disruption to blood flow to the ovaries can compromise their function. So clients continue to have discomfort or not feel better.

And then, you know, again, tongue in cheek clients come back in and they say, I’m still not having desire for sex. I have discomfort. I’m losing my memory, I’m irritable, I’m still anxious, or whatever the situation may be. And then as a gynecologist we’re like, well, let me refer you to my friend, the psychiatrist, and this is a good divorce attorney I’ve used. Do you know what I mean? So that’s kind of like the standard and that’s what happens. And it’s still happening today even though it doesn’t need to be. Because when I started with my functional medicine approach, and I’ll tell you what that is in a minute, but I went from doing two to three surgeries a week to two to three a year.

Robyn:                                And that’s because you found better solutions that don’t involve cutting people open and cutting things out, Right?

Dr. Anna Cabeca:              It’s because I asked why. Why is she experiencing these symptoms? Why is her bleeding irregular? Why is she having neurotransmitter issues? We call it all hormone imbalance, right? And I call it the devil’s triad. Hormone imbalance, inflammation and adrenal dysfunction. So those three things, we’ll put our bodies into havoc. So just by healing the underlying cause, and that’s what I kept thinking to myself, how do I get to the underlying cause of what she’s experiencing?

Because the uterus is a symptom. The uterus is a victim of the underlying hormone imbalance issues, right? So that bleeding, we can get that under control. The painful periods, I’ve had clients who have painful periods for 20 years, in two months we can get those gone. I mean it’s a reality, I’ve seen it time and time again.

The infertility, the endometriosis? Why is that going on? And you know, we ask the questions, we do the right interventions. And again, 90% of it’s in the patient’s control through nutrition and lifestyle. And then again, the little help that I can give, I’m claiming 10% for me, Robyn, I want to keep something to say that I’m part of your solution, right? But it’s probably 99.999% of the patient’s hand for sure. So those things make a difference.

So from when a patient came in and I started asking these questions, I have them do a questionnaire and it’s the same questionnaire that I put in my book called “The Hormone Fix”. And I put these questionnaires in because I want clients to know what they’re experiencing. And to repeat the test in two or four weeks and see that those numbers get better, so that their changes are making a difference. That’s really important for us to know. We need that feedback.

So when a patient would come in complaining of irritability, PMS, or irregular bleeding, I could say, “okay, well let’s run some blood work and while we’re waiting for the results, do my 21 day detox”. So I put a similar one into my book. But 21 days. And while you’re doing that, and essentially it’s a modified elimination diet, lots of Greens, check your urine pH, let’s get that alkaline. Food and stress can really impact that urine pH, so I want to see that urine pH at 7.0 or above. And maybe I’ll put them on a bio identical progesterone cream. And you know, when I was able to, like a couple key supplements, like omega-3 fatty acids were really big and then I was big with my “Mighty Maca” supplement. So I could say, okay, these things.

And they would come back in in six weeks for blood test results and to let me know how they’re doing. And they would say I’m 90% better. 90% of their symptom scores were reduced. That was huge. That was huge. Those little interventions would make a big difference. And then if they needed a little tweaking with additional bio-identical hormones or whatever, I could do that too. But through that practice, I saw women restore normal healthy function.

So when I was hit with menopause and I was doing these interventions already to some degree in my practice, it really took me by surprise and I had to understand more about what’s going on in the underlying issues with our body and to not just address the minor hormones, estrogen, progesterone, and testosterone, but to really dig into the major hormones such as insulin, cortisol, and the most powerful hormone of our body, oxytocin.

So for each of those clients that are feeling that, you know, after hysterectomy, I always tell clients, we’ve removed the uterus, but have we addressed the underlying cause of the problem? We still have to address that with or without a uterus. And often women who have had hysterectomies are told they don’t have to be on progesterone. I address this deeply in my book. But that’s a misunderstanding because progesterone receptors are in our brain, in our breast for protection, in our bones for rebuilding and in our fascia for flexibility and strength.

So for the woman who had the prolapse, we would add on progesterone and androgens topically along with good pelvic floor exercises. Believe me, I’ve delivered almost a nine pound baby. I’ve delivered four children vaginally, so I know that we can restore the pelvic floor and that’s important. That’s an important aspect of our life. And the vaginal dryness and those changes that continue, I’ve suffered them. We don’t have to.

That’s why I’m an advocate for using natural solutions through healthy fats in our diet, healthy greens in our diet, so powerful. You know, I start my day, I had a green smoothie this morning, Robyn, you’ll be proud of me, I love it. And I start my day that way. But also adding in, you know, for example “Julva” solution that I created the anti-aging cream for our vulva. Because you know those changes are happening and they affect our quality of life as we saw in the Facebook live. I mean, women are suffering needlessly, these situations can be reversed.

Robyn:                                Yeah, that’s what we want to hear because it was really eye opening for me to do that Facebook live with you. Where almost 20,000 women have tuned in, and hear them talking about these pelvic floor issues. And I was like, Gosh, Did I just get lucky? Because I’ve never liked sneezed and accidentally peed a little bit. I’ve never had any of these sexual health issues and I did deliver four vaginal deliveries at eight pounds or bigger, all of them. And I’m sure that my high greens mostly plant based whole foods diet is part of that. I’m doing that for 25 years now really, really consistently.

But you were given an award on the stage last summer. I watched you with your beautiful gown, receive an award from your peers, there’s over a thousand health and wellness practitioners and influencers and we voted and you won the “2018 Innovator of the Year”. I mean, when it’s a jury of your peers, that’s really meaningful, right? This is not a fake award, but it was a slam dunk for you, it was amazing. I was sitting in the audience going, “well, I know why that product she has, “Julva” is amazing.”

And I sort of raved about it on the Facebook live. I have absolutely loved this product for variety of reasons. It’s entirely bio identical. It’s botanicals and it’s a bunch of natural synergistic ingredients that improve your vulvular health. I probably mispronounced that. But what I would like to do is I want to send you to our blog post where you can get a deal on that product or some of Dr. Cabeca’s other really amazing products. But I’m in love with this stuff. I’ll never be without it. And it’s sort of DHEA based. But, I’ll let Dr. Cabeca tell us about it and what it works for, what kinds of issues it helps for.

But on this blog post that I want to send you to, in addition to links to that, there is a guest blog post that Anna did, which I think is outstanding covering a lot of these different topics. Her little video about how to do kegels right, cause that has to be part of the equation. Right? We gotta strengthen our pelvic floor.

And you know, we won’t be able to cover all of these topics in great depth. So make sure you go, and this is the weirdest URL, I’m sorry about this weird URL I’m gonna send you to. I don’t think we were like thinking this through that I was going to have to say this on a podcast later, but all of that can be found on this blog post at: greensmoothiegirl.com/vaginal-dryness.

Yeah, I know, I know. I don’t know why it’s called that. It doesn’t even scratch the surface of what this blog post is really about. But when we say vulvular health or whatever, I feel like, I don’t know, Why do I need a healthy vulva? Doesn’t my vulva just last me till I’m 120? All these issues. It’s like these women that were on our Facebook live. They could not get enough of you. They wanted to ask you 17,000 questions. It was amazing. They were sharing it all over the place.

But I want anybody listening who’s interested in any of these issues to go to greensmoothiegirl.com/vaginal-dryness. For more information about any of these things or links to what we’re talking about. But I felt like these are issues, the volume of questions that were coming in, it’s like these women were like, we don’t have a place to talk about this. This is not polite conversation. This is not something we talk to our own husbands about. We don’t even know how to talk to our doctors about it. And so it really made me say, hey, let’s also have you on the podcast and ask some of these questions. So I said a lot there. Let’s go back to what the heck is in this “Julva” product and why I love it so much.

Dr. Anna Cabeca:              Oh, I’m so glad you do. And also really Kudos to you because you’ve created this safe space on Facebook. I mean, how’d you do that? That women feel comfortable talking about it. That just attributes a lot to you, your character, your openness, your authenticity. So congratulations for that. Because you’re absolutely right. Women feel even uncomfortable talking to their own doctor about it, let alone their own husband. Right?

And a couple things I want to mention before I talk about the ingredients in “Julva”, is because these were things that I saw over and over again in my practice. You know, I saw women disconnecting from their husband that they love, right? And there’s a couple reasons, but you know, one thing is if you have discomfort every time you have sex, why would you want to have sex? Right?

And sometimes we don’t even think about it. We may have discharge after intercourse, odor after intercourse, not feeling the pleasure, not having the orgasm, feeling like, okay, we’re just powering through so we can please our mate. When in fact that’s not okay. And you don’t have to just power through.

These changes to the vagina have been occurring sometimes naturally because of hormonal decline, but sometimes also because of, you know, chemical toxicity. So from pads, laundry detergent, anything that attaches our vulva, vaginal area can be absorbed. So perfumes, deodorants, soaps, all of that stuff can affect the natural health of our vagina and the bacteria within our vagina.

Even if we’re on antibiotics, we know we can get yeast infections. Well because the vagina is essentially an extension of a healthy, you know, essentially a healthy gut, if we think about it that way, but we take it for granted. And in medicine certainly still, so many docs don’t think, okay, probiotic after antibiotic if we have to give one. But we need to, we need to as women really be advocates for our vaginal health because it causes suffering.

And then as hormonal decline occurs into our sixties and seventies etc, I mean we need a healthy functioning pelvic floor. Like you said, you know the accidental leak when we cough or sneeze or when we exercise, that isolates us. That keeps us from going on outings sometimes and I’ve heard it from my patients, it isolates them in their house. It stops them from exercising or running or doing some activity that they’ve really loved, yoga even. So we have to keep the pelvic floor strong.

And Robyn, you’re way ahead of the game because you’re already a natural athlete, you work out consistently and you have a very healthy plant based diet. So those are, I think, again attributing to your overall health and it’s like keep it up, right? We can never stop, because just like we have to do Kegel exercises till we die. It’s important that our nutrition and other factors in our life are really healthy.

And incontinence is an issue that is plaguing millions of women. And you see the ads for incontinence pads and incontinence panties, and you know, we’ll deliver them in a brown box to your door so you don’t have to be embarrassed to go to the grocery store and pick them up. I mean, it’s a real shame based topic. Same with vaginal dryness, same with discomfort during intercourse. These are shame-based topics. If we keep them shame based, women will continue to suffer.

So if we’re experiencing it, we have to talk about it. And one of the things that was a big eye opener to me is that the number one reason why caregivers put their loved ones into a nursing home is because of incontinence. And you know, we both have four children. Like for me, I’m not giving my kids any other excuse to tuck me away somewhere. So pelvic floor health is important for the rest of our lives. So with that said, just so passionate about women not taking it for granted, not powering through it.

Robyn:                                Yeah. That just gave me like chills, the bad kind, cause not only do I not want my kids to put me in a home, but I also don’t want my kids to have to change my Depends, and I’m not saying that to shame. It’s just heartbreaking and it’s not sustainable. It’s not sustainable to have painful sex. It’s not good for your relationship. All this stuff.

I don’t know that I nurtured anything on Facebook, it’s not that I’m so credible, as much as I was like, we’re having this conversation ladies, and we’re going to talk about libido and what happened to yours and we’re going to talk about what happens when you sneeze. And it’s like the flood gates opened. And I think that there’s actually a mechanism in these botanicals, in this product that affects all those things. So we’ll start with what’s in it.

Dr. Anna Cabeca:              Yeah. So when I retired my clinical practice in 2014 at that time I was, you know, an expert in prescribing bioidentical hormones and I was a sexual health expert, I am a sexual health expert. So vaginal hormone prescribing and you know, reversing incontinence, etc, with vaginal hormone prescriptions, and created all kinds of fun stuff to help with sexual health too. So when I closed my practice, my patients cried for help. They’re like, no one will prescribe this for us. What can we do? And I’d had earlier in my career, I had a skincare cosmetic line. I’m like, well, of course I can create a topical for the vulva. I can create an anti-aging cosmetic cream for the vulva, just like we have for our lips and our eyes and everything else. Right?

Robyn:                                Men have Viagra but what do we have?

Dr. Anna Cabeca:             Yes and men have Viagra and everything for women has failed, side effects have been too dramatic and it’s been a challenge. So for me, because I’d been working kind of compounding prescriptions for a while, I wanted ingredients that, you know, if we’re going to use something on our body, number one, it has to be natural. So I say, if you can eat it, you can put it on your body. So I approached it with that concept. And one of the ingredients are stem cells from the Alpine Rose. And this is really a beautiful flower that blossoms in the Swiss Alps amongst the harsh conditions of the ice and snow of the high altitude Swiss Alps . And for me that was just symbolic of women. You know, we are resilient and we will shine our beauty in the most harshest circumstances and that defined women for me.

And I looked at the chemical properties of the plant stem cells from the Alpine Rose and what research was showing. So it improves resilience of the skin. There’s an antiviral component to stem cells, which is important because so many women deal with HPV, HSV and what are we doing? Just saying we’ll detect it and we’ll let you know when we find it again. We got to stop that kind of reactionary medicine. So I like the little anti-aging support here to keep the cells healthy. So plant stem cells from the Alpine Rose.

And the second ingredient is DHEA. So DHEA is naturally produced in our bodies. We have natural DHEA produced by the adrenals and it is known to have really good properties for sexual health libido and also for structural support. So for example, we know that people with healthy DHEA levels have good muscle, have lower incidences of illness or auto immune diseases. And so that’s important. But there’s great research done. I’ve been studying this research for over probably almost 20 years now out of Canada, looking at vaginal DHEA and the safety and efficacy of vaginal DHEA. And that information is in that blog at greensmoothiegirl.com/vaginal-dryness. So read that information because that’s really powerful stuff.

So that’s DHEA. And then emu oil, because emu oil is just naturally healing and nourishing to the skin. And it really helps the penetration of the ingredients. And coconut oil for all the benefits of coconut oil that we know. And as well as some Shea butter so it gives a beautiful creamy consistency. There’s no fragrance in it and it smells good, tastes good, completely safe for partner and you. And we’ve gotten amazing results, amazing testimonials on this product. And I’m really glad. And for me too, I was like, I don’t want to have to insert something vaginally, number one.

And so I created it as a topical anti-aging cream. And that way you just apply it clitoris to anus, don’t forget all the tissue, the pelvic floor, our bottom, all that tissue is subject to thinning and tearing and weakening. So we want to keep it healthy. So use it entirely on your bottom and we get the great results. I hear from so many clients, improve vaginal moisture, their own body’s natural moisture, no more leaking when they cough or sneeze, as well as improved orgasms, sensation and pleasure. Yeah. So, I just thank God for giving me the guidance, the knowledge and the clarity to create this product and that it’s really helping women with these situations.

Robyn:                                How about your topical progesterone? Tell us a little bit about that. And do all women at this point over the age of 40 need to be using progesterone? Until talking to you, I had thought that we only take progesterone if we’re tested and were low in it. I was very low in it when I first started testing. I annual test now and I get everything tested from estrogen, progesterone, female testosterone, my thyroid, all the different thyroid markers, antibodies, vitamin D, I know how much DHEA I’m producing.

Well now I’m gonna go sideways for a second, because I’ve been taking oral DHEA, but your product, putting it on topically has been just game changing. It’s been amazing. Talk a little bit about the bio identical progesterone. Do think it helps with a lot of these same issues. We’ll put a link to that as well in the blog post greensmoothiegirl.com/vaginal-dryness. I can’t believe how many times, that’s just a terrible thing I just said, but…

Dr. Anna Cabeca:              I love it. So, yeah, I’m an advocate for progesterone, bioidentical progesterone. I take it myself. I have since my mid to late forties. Because every time I tested in clients over 35, certainly over 40 or 45 it’s low. And we know progesterone opposes estrogen and is part of that balance, that’s important. Progesterone has protective effects for the brain, the bones and the breasts. Three main areas. But also now research is showing, and I talk about this in my book, that there are progesterone receptors in the fascia. So, you know, pelvic floor prolapse, discomfort, the loss of elasticity, pain and aches in our joints. When you start on progesterone, a lot of that goes away.

So that’s really powerful and of course it’s a natural decline, but I believe it wouldn’t be so significant if we lived out in nature. Right? Again, we don’t have case control studies or cohort studies to look at this and put a group of, you know, 50 year old women out in the Amazon for eight weeks or longer compared to our current internal lifestyle living indoors. But I do believe that there would be a difference in our hormone balance for sure. Right? We get a lot more than vitamin D from the sun.

But that aside, I find that women do benefit from progesterone. But we want to do everything in addition. So the lifestyle changes, supporting the adrenals, stress management, perceived control of stress is so powerful. Right? So those are aspects that we need to do regardless of if we’re supplementing with hormones because it takes more than hormones to fix our hormones. So progesterone, yes. And I use progesterone and pregnanolone because of the brain protective benefits and I love that. And I add natural peptides into my formula so that we have the anti-aging skin benefits as well.

Robyn, I’m laughing because I’m like, hey, if I’m applying something to my skin, I want it to have like extra anti-aging benefits too. You know what I mean? So the hormones certainly do help, but also adding essential oils and good ingredients make a difference. And I want things that are paraben-free. Parabens, you know, disrupt our hormones. So why would we put on something that’s supposed to help us and it has chemicals in it that can disrupt us? So that’s the challenge that I have in prescribing certain formulations. And why I wanted to create something natural and balancing.

Robyn:                                Yeah. I learned from Dr. Rob Jones when he came to our Swiss retreat, he showed up with his wife and his wife is a LDS or Mormon General Authority, but turns out he’s a natural hormone replacement doctor here in Utah. And listening to him lecture to us in Switzerland, I had him do a guest lecture, I realized I’m taking way too much progesterone. So I cut it in half and I no longer was like, just couldn’t get out of bed in the morning. I mean I could get out of bed but I was just tired. And something he said triggered that.

So this is a perfect time I’m going to start trying your topical progesterone because I just cut my progesterone in half, despite the fact that it was in optimal levels, but I didn’t like taking the prescription of the bio identical. I didn’t really like how it was kind of putting me almost into a coma at night. I’m going to try yours and then continue using it until I test again in the spring. Where do you put it? Where do you apply? And when do you apply this topical progesterone and pregnanolone cream?

Dr. Anna Cabeca:              Pretty much anywhere and rotate sites. So with topical progesterone I recommend rotating sites. And you want to put it on thin skin. So where you see vein, lower abdomen, chest, in our arms, behind the knees. And I always caution if you have small children, put it in places they’re not going to touch and keep your own hand towel. Just like I do guys with testosterone or any other cream. And that’s why I prefer injections for men with testosterone.

Just a little aside, but you know, keep your own hand towel so the kids aren’t accidentally getting some cream on that. So rotate sites. And I always put a little around my eyes, on my neck, you know, sometimes on my hairline, it’s good for hair growth too, that I found. And so that’s where we rotate sites, and a little bit goes a long way.

And transdermal, we bypass the liver. So the difference between our transdermal and our oral progesterone is that transdermal, we bypass the liver. So we don’t get that conversion from progesterone to allopregnanolone causing that sedative effect. Now I love that sedative effect if we need to get people to sleep. So that’s when you know prescription oral progesterone is preferred. But you know, topical is also relaxing. It doesn’t go through first pass metabolism through the liver. So it’s safe and it is easy to use.

The thing to know when we go to switch to transdermals, we’re not necessarily going to see them in the blood. So the next round of testing could be like the Dutch test by Precision Analytics, something like that cause we won’t see your serum progesterone level necessarily bump up.

Robyn:                                Okay. So since I just slashed my progesterone by half and I’ve been feeling great since I did that six months ago. It’s not going to put me to sleep if I use the topical in the morning to kind of spread it out, right?

Dr. Anna Cabeca:              Well it might? You might feel relaxed. You have to kind of see how you feel with it.

Robyn:                                So you know, I think that women think when we talk about sexual health, they immediately go to sex. And you know some women are sexually active and some are not, or it’s an issue or it’s not. But sexual health is a lot more than just our sexual relationship. And so I hope everyone’s listening to this regardless because it has everything to do with your aging and how you feel as you age, because there’s no stopping the clock, right? But let’s talk to women who are sexually active in a relationship.

We had so many people ask about low libido issues. And I literally went through and looked at their ages because they all wanted to tell us how old they were. They were all like 55 plus, and I kind of got bad chills again, like, oh no, is this what comes with being 55 plus? You and I are the exact same age, we’re coming up on that. What do you have outside of, so we’ve talked about the topical pregnanolone progesterone product. We’ve talked about “Julva”, all part of the equation. What else you got for ladies with low libido?

Dr. Anna Cabeca:              Yeah, well definitely “Mighty Maca Plus”, right? We want to keep the adrenals healthy and keep, you know, estrogen, detoxing healthily and keep our liver functioning well. All those good things, right? So that’s important. Keep up having your green smoothies, I mean, I can’t say enough about them we’re totally in line with that. And that’s important that we get these healthy nourishments don’t stop that.

But let me tell you, one thing that I heard a lot in my practice was, like a patient would come in and I’d ask them about their libido, and invariably she’d say, “Doctor Anna, I have no libido. I have no desire, but I’m okay once we get started”. And after hearing that a few times, I had to really research it because, you know, we studied way back in the 90’s in my medical school, etc. We studied the Master’s and Johnson Linear Pelvic sexual desire model, which is very linear and it’s a very manly model.

But there was a study done by a researcher called Dr. Basson and he looked at what women’s sexual desire really is. And it’s a secondary desire. We don’t have the initiative necessarily, but as long as we’re receptive, once we get started and oxytocin starts, we start to feel pleasure, we start to allow ourselves to be present that desire comes in, we’re okay then, we’re turned on, we’re like, okay, now I’m in the game type of example.

And that is really interesting, and I call it like the game of “Candy Land” if that brings a visual to your mind, if you’re listening to this, you know, the board game with all these pathways and sometimes you get stuck in the mud, sometimes you have to go back to start and then sometimes you get an ice cream cone, right? That’s kind of like a woman’s natural sexual response and that’s okay.

So, it’s being receptive. Like if you’re like, okay, I have no libido. So then it becomes a discipline and a practice to allow yourself to be receptive, to be open to the idea, to set date night, to set time to have pleasure, share pleasure, receive pleasure and that’s critically important. And your guy wants that, you know, he wants you to be happy, he wants to know that he’s made you happy and has pleased you.

Whether you have a climax or not, the entire experience can be orgasmic in that we’re increasing oxytocin, that hormone of love, bonding and connection. And it’s an anti-aging hormone, a natural analgesic, a natural anti-appetite suppressant, a natural pain reliever, like I said, all these good things and it rebuilds muscle and is associated with joy, peace and happiness. So, you know, be in it for that.

And then secondarily, it’s like for women, desire starts, I would say, foreplay starts with, you know, you bring me coffee in bed in the morning, alright, we can talk later. But you know, you communicate that, hey, these are things that I love that make me feel receptive and open to having sex with you, honey. You know, you share that information and make it a discipline and a practice and allow yourself that natural time to have pleasure to experience pleasurable touch.

And even women who have been married 30 years sometimes haven’t communicated what feels good and what doesn’t feel good. And that’s so important. That’s so important. And you know, I love this topic because it really does open the doors to having more loving relationship.

Robyn:                                Yeah. And we’ll go sideways here too, a former sex therapist, and we’re talking to a lady doctor and she’s recently retired from treating women for sexual issues. And I’m a former sex therapist. Can I just say that I trained my guy that when he comes in hot at a six I always say, hey, you go from a 1 to a 10 really pretty quickly. You came in at a six but I’m at a one. And I make cute jokes about it so that there’s no shaming. I say, Hey, I need you to take me from a one to a two or three.

And whatever a one looks like for you and really being clear and communicating. Like, you know what taking me from a one to a two looks like. It’s like when you come in and I’m standing at the sink when I’m chopping vegetables or doing the dishes, pull my hair off my neck and kiss the back of my neck, ask me what you can do to help. Whatever it is, if your love language is service, like they have to be trained, they think like they think. And so these are the sort of hard to quantify things that we really need to communicate to our partners. They don’t know until we tell him.

By the way, another side note, Gosh, it’s trending out there for women, I see this on Facebook a lot in some private groups that I’m in, of women saying my sex drive is bigger than my husband’s. What is going on with my husband? And I see a lot of women out there saying, you got to get your husband on testosterone. Can I just say, you don’t need to get your husband on testosterone unless he’s low in testosterone. Please get him tested before putting him on testosterone. And this is my opinion, we’ll see how Anna feels about it. Please don’t do the implant thing under his skin. Do you agree with that or not?

Dr. Anna Cabeca:              Well, I will tell you that I agree with everything you’ve said and I love what you said about going from one to two and guiding and teaching and training. We do have to, and that just like brings the juice to the relationship. That communication, right? When it comes to testosterone, now I’ve treated men and women and I’ve lectured and trained physicians in prescribing bio-identical hormones. And there are many ways, but for men, I typically like, again, they need to be low and we need to figure out why their testosterone’s low first and foremost.

If they’re on a statin medication to lower their cholesterol, that’s going to lower testosterone. And then we can ask why was cholesterol high to begin with? Was it heavy metal toxicities? Was it Thyroid disease? What’s going on to make that high? We need to solve the problem before we supplement.

And because I have now had clients come to me who were in their late twenties who had been treated on testosterone since their early twenties for low testosterone levels. Did anyone ask why? No. But we’ve almost pretty much sentenced them to a hypogonadal state. So we can’t do that. So what we have to do, we need to ask why?

Why is the testosterone low and how can we improve it? Detoxification, right? Hormone disruptors? Where are they getting xenoestrogens in their environment? Are they drinking out of plastic bottles? Is there lead contamination in the water? Are they eating lots of grains that could have an effect on their hormones in their body? What’s going on? They’re dealing with constipation, so now they’re getting extra estrogen within their body and that’s going to effect and increase testosterone conversion to estrogen as well.

You know, where is their testosterone going if we’re not seeing it, is it going to dihydrotestosterone or estrogen? We need to ask those questions. Are they zinc deficient? You know, the list goes on. Do they need adrenal support to increase their DHEA? Or are they dealing with a lot of stress, environmental, physical, emotional? What else is going on? We’re going to suppress our reproductive hormones.

So nothing makes me a little bit more fired up, if you can’t tell, then seeing someone, who’s prescribed something without ever being asked, why is this happening? And that’s where I would say get our Nancy Drew on, we’ve got to figure it out.

So, and then for men, I like injections because number one, we can on a weekly basis, a small dose injection they administer themselves, easy, clean and we can keep control of that dosing. Also because physiology affects our behavior and something I have absolutely scolded physicians on are prescribing higher doses of testosterone or allowing patients to have higher doses of testosterone, which is also something that pellets do. They get a really high peak of testosterone.

Robyn:                                And just to clarify, that’s what I was talking about when you put the pellets under the skin and they might misfire, you know, you can’t just stop the injections like it’s under your skin. So it’s hard to get rid. There’s infections. I’ve just heard so many funky things from that. I think it’s sort of based on theory. And I don’t think that whole little trend is going to last long. I just don’t, I don’t like that.

Dr. Anna Cabeca:              Yeah. And you can’t control it. It’s in, it’s in. And sometimes we need to like, okay, you’re dealing with severe depression or something else is going on. Let’s just do this so we know you’re doing it, right? And you know, we’ll come back later and even it out. But injections and also I would do sometimes for women testosterone injections because the creams, the gels, they get on your mate. I’ve had women with high testosterone levels because their husband was on a gel. And there’s a case report of a child with testosterone levels in the thousands because of their father on testosterone. So we have to really think about those things. You know, we’re taking it in, what’s happening?

But I’ve scolded physicians for that higher dosing because it affects behavior. And that causes dopamine seeking behaviors or thrill seeking behaviors, novelty seeking behaviors, and hence sometimes affairs. When I would treat a woman, I would treat the husband and vice versa, treat the husband, treat his wife. And so a patient, he came to me and interestingly I worked with him on small dose of injections on testosterone while we were doing everything else. And I said, if you feel any different, if you feel like you’re out of sorts? You know, any unusual behaviors? Irritability? Let me know.

And he called me, he says, Dr. Anna, I’m feeling and I’m having thoughts that I don’t want to be having towards a woman who’s not my wife and I should never be having these. I don’t want to be. And I’m like, let’s check your levels. Stop the testosterone and let’s see what’s going on. It turns out that he was taking more testosterone than what he was prescribed. And his testosterone levels were like 1300, 1400. And he had the wherewithal to say, look, I’m not acting like myself.

And we do that with testosterone, we’re causing that. And I’ve talked to some of these clinics, for example, many of these anti-aging clinics, I deal predominantly with men and testosterone. I said, what’s your divorce rate? They’re like very, very high. And in speaking with people, I said, well, when did you decide to divorce your wife? And then timing it till after the testosterone injections started. So that’s not what we want. We want love, unity, connection.

So it’s important. We need to ask why the men are experiencing low libido. It’s a real phenomenon. A lot of it’s estrogenization, and we can fix that, right? We need to look at what’s causing it and address those causes. So, I talk a lot about endocrine disruptors in my book, “The Hormone Fix” and get into more detail on that. And also stress and how that can affect your hormones. And it’s important for men and women to identify what’s causing me to feel this way.

Robyn:                                Yeah. Not to mention the being quick to anger of our guy if he’s got too much testosterone. It’s just not a recreational supplement. It’s something that they should be being tested as well. So yeah, that’s not going to do much for your libido if your guy’s mad all the time. So…

Dr. Anna Cabeca:              No. Physiology affects behavior and I think that’s what’s so powerful.

Robyn:                                Yeah. You mentioned a third product that you have, that I also think is really innovative. I have it. I really like it. I want to work it more into my diet. It’s your “Mighty Maca”. We’ll put a link to the special deal on that as well on the blog post that I’ve mentioned several times. And “Mighty Maca” is actually a drink. You put a scoop of it in water, it tastes delicious. You could throw it in your green smoothie as well. And it’s greens, but it’s also maca. I think I read that like Incan warriors were the first that we know of to use this. And it’s not really a stimulant, but it gives you energy. And with energy, there’s always going to be sexual energy.

Oh, and a little side note here, I almost wrote a book called The Amazing Sex Diet, except that my agent didn’t want it. She said that book publishers wouldn’t want it because it’s just not women’s pain point. And here’s the thing, like the book would really be for men and guess what? Women are the ones reading the books for the most part.

But my point is that, you know, just like I’ve coached my readers for many years, if you want your kids to eat healthier than put it in terms of things they care about. You know, talk about when you have your green smoothie, you’re going to perform better in school. And here’s why. Here’s what the operator is here, here’s what the mechanism is here. Don’t give him a 10 minute lecture. Give them a 30 second drip but do it often.

Same thing with our man. I don’t think men realize, even though over 40 men like something like 40 plus percent of them, fairly regularly experience that they can’t get it up, keep it up or finish, and they don’t realize that that is incipient heart disease, that early cardiovascular disease shows up as sexual dysfunction.

And so that was really going to be what I wanted to write the book about it. But all my medical doctor friends were saying, Don’t write it because women won’t buy it because they’re not really worried about their libido as much. So that’s really sort of a secondary issue. But just if you want to drip on your man about eating healthier, little tip, connect it to his sexual performance. Because if you don’t have lots of fiber cleaning out the arteries, wonder what Dr. Cabeca has to say about this, men and their sort of crappy diet, the vast majority of them, they think if they eat a salad once a week, they’re good. I don’t know what it is about men. I don’t know what it is. But what do you have to say about that? That the amazing sex diet is a whole foods diet and the way they eat absolutely affects their sexual performance?

Dr. Anna Cabeca:              Yeah, 100 percent. And I would buy your book The Amazing Sex Diet, Robyn. So when you write it, I will buy it.

Robyn:                                Let’s write it together.

Dr. Anna Cabeca:              We’ll, do it. And you know, when you talk about erectile dysfunction, right? ED, it’s epithelial dysfunction. So cellular dysfunction is a cause of erectile dysfunction. And it’s the same with women, except men have a very obvious symptom, right? They can’t get a hard on. For women we, you know, clitoral decrease in sensitivity, decrease in orgasm, decrease in sensation. We’re experiencing it too. And it’s the same way we have to have clean, healthy, flexible arteries and it’s important. So diet is huge. We’ve got to have the natural roughage to clean out the cells and have healthy fats for a healthy cell membrane. And it just stems from that.

And one of the reasons I created “Mighty Maca Plus” was part of my own journey with diagnosed with infertility when I was 38 and menopausal, right? Premature bearing failure. They told me, Anna, you know, nope, you’re not going to have any more children. And you’re just going to have to deal with it, you know, and this is the best it’s gonna get. So that’s what I was told. And fortunately I had a glimmer of hope, a lot of faith in God and at 41, I conceived the baby.

But part of that journey was going to Peru. And when I went to Peru and I said, I was infertile, they said, well, take Maca. And they said, if your child’s not thriving, take Maca. If you’re tired, take Maca. And then they elbowed my husband and say it’s the Peruvian Viagra. And I’m like, yeah, right. Like I’m a researcher. Yeah. Give me information on this.

So, you know, number one, first of all, I was desperate, so I took Maca, and it tasted terrible. And so, let me tell you my “Mighty Maca Plus” tastes amazing because I think we should enjoy what we do, even the medicinal foods that we take. But also because I couldn’t stand the taste of Maca and I had to create something that was pretty amazing.

So I had to research it. And yes, the ancient Incan warriors would take Maca before they went into battle to give them more stamina and strength and perseverance. And it’s also, you know, a root that grows only above 11,000 feet in the Andes. And I looked at the research, I looked at what makes this Maca, which looks like a beet essentially, or a root vegetable. And it’s actually in the cruciferous family.

So I’m like, okay, well that’s good cause cruciferous vegetables are breasts healthy. So what else has Maca got? And has its own specific proteins called macaenes and it’s rich in arginine. Well, lo and behold, arginine improves nitric oxide synthesis, which is exactly how Viagara works.

And I thought, wow, something to this. And certainly we get a lot of feedback with “Mighty Maca Plus” that it improves libido, improves energy, improves erectile function and energy. That’s a real big one, that non-stimulant energy just that get up and go.

And in fact we had a client, she’s a 37 year old yoga teacher in Washington DC and her husband is a contract with the military and he would just come home and sit on the couch, he was exhausted. So she started making him, lo and behold, green smoothies in the morning and put in a couple scoops of Maca in it. And now he has energy, he’s like finishing the to do list. He’s like a whole new person she said and his interest and desire is back. And that was just in a few short weeks. So that’s key. It can make a difference when we give our body the right ingredients.

So in addition to Maca in “Mighty Maca Plus” it’s a superfood combination of over 30 superfoods. Some that I experienced personally in my world journey, but all that I’ve researched well. And so tumeric, quercetin, resveratrol and all of those are genetic adaptogens, which are really powerful. And the ingredients work on multiple angles. So the cytokine pathways, inflammatory pathways.

So I had mentioned earlier that inflammation is one of the root causes to disease as well as hormone imbalance. So the way I formulated “Mighty Maca” was to help with really both of those issues by supporting our body’s natural processes, adding fiber, enzymes, extracts, and make it taste good.

Robyn:                                Yeah, actually it does taste good. And no yucky preservatives or sugars added. So, great job with all three of these products. Anything we haven’t covered that you want women to know? We took a little detour on male sexual health and I’m glad we did because you know, I noticed that women tend to take responsibility for the health of their families and they’re often their husband’s coaches in these areas, some men are more receptive and some more resistant.

But when you tell them that your dietary recommendations have everything to do with what they care about most, they’re going to hear it better. Especially if we leave the door open and we don’t do it in a shaming or judging way it can be really, really useful to them for their long term health as well. What did we miss? Anything about aging gracefully for the ladies that we haven’t talked about?

Dr. Anna Cabeca:              I think we really hit on a lot of good parts. I used to give a lecture called “aging gracefully from the gynecologist perspective”. So we’ve covered all the vaginal health topics pretty much, right? Really important and definitely in the blog: greensmoothiegirl.com/vaginal-dryness.

Robyn:                                So glad you said it because I’m so done saying that.

Dr. Anna Cabeca:              I love it. And so we cover even more in depth there. It’s just also never give up on yourself. I think that’s a really big thing is you know, whether you’re in a relationship or not, I mean self-pleasuring, that’s really important. I mean don’t give up on yourself and don’t forget about this important part of your health, your pelvic anatomy, because we need it for the rest of our life. So a little, you know, we say an ounce of prevention is worth a pound of cure, and it’s so true, especially when it comes to the pelvic health.

And even if you’re struggling, if you’ve been diagnosed with, you know, whatever, know that you can get better. You can be better tomorrow than you are today. Don’t give up. We have dreams for a reason and we’re meant to fulfill them. So just take the next right step for you. The next one right step at a time and enjoy.

Robyn:                                Yeah. I posted a photo of you and me on the Green Smoothie Girl Facebook page when we were announcing the Facebook live, which if you’re looking for it, I think we did it on like Valentine’s Day or right after something like that. And it was this photo of you and me and I looked at your photo and I was like, that right there is what I want my lady doctor to look like. You have home court advantage, you have been through these things. You’re the wounded healer that I always talk about.

We therapists talk about the wounded healer, probably partly because we have to justify why we’re a divorced person counseling married people or whatever. But I’m being silly. We really develop a depth of knowledge as well as the compassion and the big heart that goes with it when we’ve had our own suffering and I so appreciate what you’ve done with your own trials. You’ve had some major trials in life, my friend and I greatly respect you. And thank you so much for sharing so much with my audience.

Dr. Anna Cabeca:              Thank you so much.